Provider First Line Business Practice Location Address:
70 HOLLY HILLS MALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINDMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41822-9121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-9440
Provider Business Practice Location Address Fax Number:
606-785-9645
Provider Enumeration Date:
07/30/2006